Autism- Exploring the Possibilities. 10th September 2019

1. Autism-Exploring the Possibilities.10th September 2019 Dr Lee Sturgeon – Consultant Clinical & Developmental Psychologist

2. Learning Outcomes • To better understand the ‘autism spectrum’. • Practical strategies to address core symptoms. • Capitalising on the strengths of individuals on the autism spectrum. • To be better equipped to support and respond to the needs of those on the autism spectrum.

3. The Autism Spectrum . . .What is it ?

4. Learning Outcomes DSM-IV ASD Criteria (1994 – 2014)

5. DSM-5 – The Autism Spectrum • MAJOR changes to diagnostic categorisation. • Symptomology largely the same. Sensory included. • No “Autism”, “Asperger’s Syndrome” or “PDD-NOS” • Now implemented. • Implications for funding/ aide/ service access and service provisions. • Diagnosis is IDEALLY multidisciplinary.

6. DSM-5 – The Autism Spectrum • Persistent deficits in social communication and social interaction across multiple contexts: • 1.       Deficits in social-emotional reciprocity, (e.g. abnormal social approach; failure of back-and-forth conversation; reduced sharing of interests & emotions; failures in social interaction). • 2.       Deficits in nonverbal communicative behaviours used for social interaction, (e.g. poorly integrated verbal and nonverbal communication; abnormalities in eye contact or deficits in the use of gestures; lack of facial expressions & nonverbal communication. • 3.       Deficits in developing, maintaining, and understanding relationships (e.g. difficulties adjusting behaviour to suit various social contexts; difficulties in sharing imaginative play or in making friends; absence of interest in peers).

7. DSM-5 – The Autism Spectrum B. Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least two of the following: 1.       Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2.       Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behaviour (e.g., extreme distress at small changes, difficulties with transition). 3.       Highly restricted, fixated interests that are abnormal in intensity or focus. 4.       Hyper- and /or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment.

8. Definition – The Autism Spectrum • A lifelong developmental condition that affects communication, socialisation and behaviours that impact the way an individual relates and interacts. • Internationally recognised as 1 in 100. Some research suggests 1 in 70 or higher. • Rate of diagnosis is increasing for MANY reasons. • Genetic and environmental triggers. • More prevalent in males. Females underdiagnosed? • 15% gifted, 40% Average intellect, 45% ID

9. ASD is rarely just ‘The Spectrum’

10. DSM-5 Autism Spectrum Disorders

12. Practical Strategies - General • Build a connection. Individuals with ASD often experience social challenges. Show an interest & engagement is more likely. • Individuals with ASD are typically visual learners. Provide visual supports, drawings, social stories, charts, ‘how to….’ instructions. • Do not provide too many instructions or too much information at once. • Allow time to process. A lack of response does NOT always mean a lack of attention. • LIMIT TECHNOLOGY ACCESS.

13. Practical Strategies - Communication • Individuals with ASD are typically visual learners. Provide visual supports, drawings, social stories, charts, ‘how to….’ instructions. • Avoid too many instructions, or too much information at once. • Allow time to process verbal information. (A lack of response does NOT always mean a lack of attention.) • At least initially and when younger avoid open ended questions. • Add structure. • Avoid sarcasm. • Be specific (e.g. instead of asking a student to ‘use your imagination’ ask them to provide ‘two more details about where the story was set and what occurred there’).

14. Practical Strategies - Socialisation • Structure some free play (e.g. weekends, recess, lunch time). • Incorporate their interests where possible. Use a timer if required. • Avoid/ limit access to technology. Especially if it is solo play. • Do not match by diagnosis. Match by interest and acceptance. • Focus less on age of peers. • Encourage short periods of play and gradually increase over time. • Mini schedules. (e.g. at recess today I can …….) • Bend the rules. (e.g. first 5 minutes of assembly and then engage in alternate learning activity). • Do not expect a child on the spectrum to accurately read and respond facial expression. Especially when emotion is high. • Do not insist on eye sustained contact.

15. Practical Strategies - Behaviour • Build the relationship. • Show an interest in their interests. • Develop routines and schedules. (not all consuming). • Provide time to process changes. • Ignore small behaviours. • If a behaviour presents ask yourself WHY. Is it confusion, anxiety, lack of communication, sensory overload, unexpected change etc. • Develop ‘natural consequences’ that are meaningful. • Understand ongoing behavioural triggers and address these where possible. • Develop IEPs at school and update these.

16. Practical Strategies – Education • Do not expect lengthy written responses. • Consider using technology more for educational purposes. • Encourage short mental health/ sensory breaks WITH TIME LIMITS. Sensory toys may be calming for some. • Try to avoid multiple class teachers in primary school. • Encourage communication. Set aside 5 minutes twice a week to ‘check in’ with the student. • Just because they are not talking about issues at school does not mean that everything is OK. • Emphasise DIFFERENCE in the classroom amongst peers. Differences in sports played, music preference, favoured foods, favourite games etc. Emphasise that every student is different.

17. The Strengths of Individuals on the Autism Spectrum. “All human evolution was driven by Asperger’s and autistic people. The human race would still be sitting around in caves chattering to each other if it were not for them”. Prof Michael Fitzgerald (2006 – Irish Child Psychiatrist specialising in ASD).

18. The Strengths of Individuals on the Autism Spectrum. • Visual learner. • Creative/ Artistic & ‘thinks outside the square’. • Passionate and Focused • Honest • Focused. Not distracted by social issues. • Artistic. Musical • Efficient

19. The Strengths of Individuals on the Autism Spectrum cont . . . • Hyperlexic (but may have poor comprehension) • Can become an expert in a niche field. • Strong long term memory. • A strength in problem solving. • Motivated by technology.

20. Inventions Credited to ASD • Ipad • Multi-story building & bridge engineering. • MANY medical discoveries. • Diesel engine. • Robotic surgery • MANY others . . . • The Jet engine. • The Xray Machine. • Penicillin. • Internet and Wifi. • Computers & Coding. • Flat screen TVs. • Electric cars.

21. Outstanding Individuals with an ASD • Bill Gates – Co-founder of the Microsoft Corporation • Temple Grandin – Animal Scientist • Daryl Hannah – Actress & Environmental Activist • Thomas Jefferson – Early American Politician • Steve Jobs – Former CEO of Apple • James Joyce – Author of “Ulysses” • Alfred Kinsey – Sexologist & Biologist • Stanley Kubrick – Film Director • Michelangelo – Sculptor, Painter, Architect, Poet • Wolfgang Amadeus Mozart – Classical Composer • Nikola Tesla – Inventor • Andy Warhol – Artist • Albert Einstein – Scientist & Mathematician

22. The Gain Itself . . . It is NOT the size of a gain that should be considered important. Rather it is the meaning to the individual and his/ her family. Challenge the deficit model. For example: • A non-verbal child gaining several key signs or single words. • Initiating and sustaining a friendship. • Attending one full week of school. • General happiness to attend school following school refusal. • Attending a school camp. • A reduction in gaming. • Representing NSW at swimming with NO prior skills, just determination.

23. The Gain Itself cont . . . • Part time supported employment. 3 x 3 hours per week providing meaning, social inclusion and income. • A girlfriend or boyfriend. • Independent or semi-independent living. • A reduction in medication. • Travel. • Drivers license. • Case study . . . A train obsession.